choledocholethiasis details

Question 1

ascending cholAngitis/

tx

Answer 1

1. begin immediately :

Blood cultures; IV broad-spectrum Abx +

IV hydration

2. Biliary drainage with ERCP : performed urgently in pts w moderate to severe disease/or in pt w

persistent pain;

hypotension;

altered mental status;

persistent high fever;

WBC 20;000/mcL; and bilirubin =+10 mg/dL

Question 2

pt w gall stone/

% w stone in the CBD=choledocholithiasis

Answer 2

20%

Question 3

choledocholithiasis/tx

Answer 3

choledocholithiasis w/out ascending cholangitis;

CBD stones removed via intraoperative CBD exploration or ERCP.

Or choleCystEctomy

Question 4

pancreatitis + elevated ???

Suggests pancreatitis secondary to gallstones (GAP)_

Answer 4

pancreatitis= HIGH serum lipase (=> etiology= Gall stone) /

High ALT or AST> 100 IU/L=> GAP

BUT AST <50 IU/L=>GAP UNlikely

Question 5

pancreatitis/

imaging tests to rule in or rule out

Answer 5

rule in:

in ALL pts w pancreatitis/

Transabdominal US to id etiology of gallstones or CBD dilatation => GAP.

rule out:

Plain radiography =>no free air or SBO.

NOT CT: id pancreatitis (u can c the inflammation but not the stone) == NOT the etiology

Question 6

pancreatitis/

imaging/CBD dilatation suggesting.

Answer 6

GAP

Question 7

acute pancreatitis

/tx

Answer 7

monitoring:

in: IV fluid : to <->good BP +UO
out: +UO=UOutput

effect of in/out:VS; orthostatic BPs;

carefully monitored to assess intravascular volume.

blood/fx of pancreas: O2; electrolyte; +glucose

No oral intake

Opioids for pain relief

sx controlled: Nasogastric tube if :recurrent vomiting

ICU admission x severe pancreatitis/

Jejunal feeding;

on d/c:Alcohol abstinence

Question 8

acute pancreatitis/ surgical tx

Answer 8

CholeCystEctomy +

ERCP/sphincterotomy